Surgical site infection reduction bundle in stoma closure: A retrospective cohort study

Advances in minimally invasive surgeries and pre-operative treatments allow the preservation of anal function through lower anastomosis in patients with rectal cancer, often necessitating temporary diverting stomas owing to the risk of anastomotic leakage. Stoma closure is associated with a high rate of surgical site infections (SSIs). Various measures, including purse-string skin sutures and negative-pressure wound therapy, have been implemented, and some guidelines recommend purse-string skin sutures as the standard method of stoma closure. However, at our institution, we used linear skin closure with an SSI reduction bundle. This study describes our stoma closure method and retrospectively analyses surgical outcomes.

This retrospective study included patients aged ≥ 20 years who underwent loop stoma closure using linear skin sutures at our institution between January 2006 and March 2021. Our protocol emphasises the following: (1) pre-operative oral anti-microbials, (2) a surgical technique that distinctly separates clean and contaminated regions, and (3) wound closure to eliminate dead space. We evaluated the surgical outcomes, including the incidence of SSIs and other post-operative complications.

Ninety-two patients (53 men, 39 women; mean age, 59.4 years) underwent loop stoma closure. SSIs occurred in two patients (2.2%). No risk factors for SSIs were identified.

In our department, the incidence of SSIs after linear skin closure of stomas was low. Adherence to proper infection prevention practices can effectively mitigate SSIs, even with linear skin closure.